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What is dental insurance? Here's how dental insurance works

Dentist
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Getting dental insurance, or even understanding what dental insurance is, leads to a lot of questions  not everyone can answer. Finding the right dental insurance, much like finding the right dentist, depends on your personal circumstances and the condition of your oral health. 

For example, if you want a lot of work done, such as cosmetic procedures, you may want to opt for a plan with more coverage. Here, we'll explore the basics of dental insurance and explain how it works. 

What is dental insurance?

Think of dental insurance as medical insurance, but for your smile. Dental insurance plans work the same way medical plans do, but tend to be more straightforward than medical plans. For example, many providers will tell you exactly how much to budget for any given procedure, if need be. 

In network vs. out-of-network dental insurance:

The first question you should ask yourself when picking a plan is whether or not you think you'll stick to your current dentist, if you have one. If you like your dentist, you'll want to pick a plan where they are considered "in-network." This means that you'll pay less per visit. Choosing an out-of-network dentist or plan for which your current dentist is an out-of-network provider means you'll pay more per visit. 

Dental insurance premiums:

Getting dental insurance means that you'll pay a premium every month to retain insurance. This costs around $50 depending on your location, your provider, and your plan. Even if you choose not to pay for a dentist's services in a year, you will still pay the premium for insurance. 

Dental insurance coverage:

Your plan dictated what procedures are covered: some cosmetic procedures such as braces or whitening may not be included in your plan, and you'll end up paying full price for them out-of-pocket. 

Deductibles for dental insurance:

In simple terms, a deductible is the amount that a patient must pay before the insurance plan starts to cover expenses. For example, if your dental insurance deductible is $300, and the cost of your procedure is $175, you will pay the entirety of the $175. Once the deductible is met, your plan will likely pay a percentage of the remainder of the bill, which can range anywhere from 20% to 80%. 

Co-pay:

At the time of your procedure, you may also have to pay a co-pay for the visit. A co-pay is a fixed amount for dental work, paid by you to the dentist each time you visit. This would be defined in your insurance policy.

Dental insurance waiting period:

Like many things, the best time to buy dental insurance is when you don’t need it, or at least when you don’t need it urgently. It’s not uncommon for dental insurance companies to have waiting periods before they will cover certain major – and typically the more expensive – procedures. This could come as an ugly surprise if you wait until you’ve got a dental emergency to buy insurance, because you might end up having to pay the entire cost yourself.

An article in the online publication DentalPlans.com notes: “There is usually no waiting period for preventive care. You may have to wait for three to six months for basic procedures, and six months to a year for major procedures.” The article defines preventive care as things like checkups, x-rays, cleanings, etc. Basic care includes filling cavities, simple tooth extractions, etc. Meanwhile, major procedures include root canals, bridges, crowns, etc.

DentalPlans.com recommends that you look at the waiting period connected with various procedures before you buy a dental insurance plan.

Can I have more than one insurance plan?

It’s certainly possible to have more than one dental insurance plan, according to the American Dental Association. It’s common for an individual to have their own insurance through an employer and to also be covered by a spouse’s plan. Sometimes, people opt to pay for a secondary plan.

So who pays?

What happens is a process called “coordination of benefits’’ (COB), which works out which company pays all or most of the costs. “When both plans have a COB clause, the plan in which the patient is enrolled as an employee or as the main policyholder is considered the primary plan. The plan in which the patient is enrolled as a dependent would be secondary,” according to the ADA.

Typically, the secondary plan doesn’t pay anything until the primary plan pays the dentist. It’s common for a secondary plan to kick in to pay any remaining amount later, but only after the second insurance company gets an explanation of benefits attended to by the first plan.

So, do I really need dental insurance?

The answer to this question depends heavily on your circumstances and the state of your oral health. Considering a possible waiting period, if you think you're going to need to get more regular checkups down the line, you may want to start investing in dental insurance now. However, if you think that you're not likely to go to the dentist for a long period of time to come, you may not need it. However, keep in mind that oral health and hygiene as essential components of overall health and well being. If it comes down to your finances, do your research on plans and providers, and crunch some numbers.